Developing an in-depth understanding of patient and caregiver engagement across care transitions from hospital: protocol for a qualitative study exploring experiences in Canada.

INTRODUCTION: Patient and caregiver engagement is critical, and often compromised, at points of transition between care settings, which are more common, and more challenging, for patients with complex medical problems. The consequences of poor care transitions are well-documented, both for patients and caregivers, and for the healthcare system. With an ageing population, there is greater need to focus on care transition experiences of older adults, who are often more medically complex, and more likely to require care from multiple providers across settings. The overall goal of this study is to understand what factors facilitate or hinder patient and caregiver engagement through transitions in care, and how these current engagement practices align with a previously developed engagement framework (CHOICE Framework). This study also aims to co-develop resources needed to support engagement and identify how these resources and materials should be implemented in practice. METHODS AND ANALYSIS: This study uses ethnographic approaches to explore the dynamics of patient and caregiver engagement, or lack thereof, during care transitions across three regions within Ontario. With the help of a front-line champion, patients (n=18-24), caregivers (n=18-24) and healthcare providers (n=36-54) are recruited from an acute care hospital unit (or similar) and followed through their care journey. Data are collected using in-depth semi-structured interviews. Workshops will be held to co-develop strategies and a plan for future implementation of resources and materials. Analysis of the data will use inductive and deductive coding techniques. ETHICS AND DISSEMINATION: Ethics clearance was obtained through the Western University Research Ethics Board, University of Windsor Research Ethics Board and the University of Waterloo Office of Research Ethics. The findings from this study are intended to contribute valuable evidence to further bridge the knowledge to practice gap in patient and caregiver engagement through care transitions. Findings will be disseminated through publications, conference presentations and reports.

The Impact of COVID-19 on Older Adults' Perceptions of Virtual Care: Qualitative Study.

BACKGROUND: In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is "here to stay." As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. OBJECTIVE: This research aims to understand older adults' perspectives and experiences of virtual care during the pandemic. METHODS: As part of a larger study on older adults' technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. RESULTS: Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. CONCLUSIONS: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post-COVID-19.

Responding to COVID-19 with integrative health and sheltering models for persons experiencing homelessness in Southern Ontario, Canada: protocol for a qualitative study exploring implementation and sustainability.

INTRODUCTION: COVID-19 has disproportionately impacted persons experiencing homelessness in Canada, who are at an increased risk of infection and severe outcomes. In response to the pandemic, several regions have adopted programmes that aim to address the intersecting nature of health and social challenges faced by persons facing homelessness. These programmes adopted during the pandemic may contribute to broader health and social impacts beyond limiting COVID-19 transmission, but the processes involved in developing and implementing these types of programmes and their sustainability after the pandemic are unknown. Our overall goal is to understand the processes of developing and implementing integrative health and sheltering initiatives in Ontario during COVID-19, as well as their sustainability post-pandemic. METHODS AND ANALYSIS: This study will use a multiple case study design-two cases over 1 year-enabling us to investigate how integrative health and sheltering approaches have been implemented in two mid-sized cities in Ontario, Canada. Each case will offer a unique narrative; through cross-case analysis, the cases will highlight programme operations, successes and challenges. Data will be collected using semi-structured interviews with programme staff and managers, and document analysis. Project partners will be brought together to further explore and interpret findings, along with co-creating a sustainability action plan and policy documents. ETHICS AND DISSEMINATION: Ethics clearance was obtained through the Western University Research Ethics Board and the University of Waterloo Office of Research Ethics. Findings will be disseminated through publications, conference presentations and lay summary reports.

Performance of the interRAI ED Screener for Risk-Screening in Older Adults Accessing Paramedic Services.

BACKGROUND: Paramedics respond to a significant number of non-emergency calls generated by older adults each year. Paramedics routinely assess and screen older adults to determine risk level and need for additional follow-up. This project implemented the interRAI ED Screener into routine care to determine whether the screener and resulting Assessment Urgency Algorithm (AUA) score is useful in predicting adverse outcomes. METHODS: We conducted a population-based retrospective study using administrative health data for patients aged 65+ assessed by paramedics from July 2016 to February 2017. Patients were assigned an AUA score and classified into three risk categories. Outcome data including hospitalizations, Emergency Department (ED) visits, home care status, and survival were collected and compared across AUA risk categories using descriptive and analytical statistics. RESULTS: Of the 2,801 patients screened, 31.9% were classified as high risk, 23.6% as moderate risk, and 44.6% as low risk. Patients who scored in the highest risk category were found to have longer hospital stays, and were more likely to require home care (p<.0001). The AUA risk category also predicted survival (p<.001). CONCLUSIONS: The AUA predicted multiple adverse outcomes in this population. Use of the AUA by paramedics may aid in earlier identification of those in need of additional intervention and services.

A SHARP Response: Developing COVID-19 Research Aims in Partnership with the Seniors Helping as Research Partners (SHARP) Group.

COVID-19 has disproportionally impacted older adults, and has highlighted many issues, including extreme deficiencies in Canadian long-term care homes and gaps in home and community care services for older adults. In recent years, there has been a push towards better patient and family engagement in health system research, and with the onset of the pandemic, engaging older adults in research and policy planning is more important than ever. In this article, we describe the Seniors Helping as Research Partners (SHARP) approach to engagement with older adults as an example of how partnerships that engage older adults in the development of research aims and processes can help to ensure that future research meets the needs of older adults. SHARP members highlighted a number of areas for future COVID-19 research such as improvements to long-term care, enhancing access to home and community care, and a focus on aging and social isolation.